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CVS > Top of Cardiac Disease Table - Important hx > Flashcards

Top of Cardiac Disease Table - Important hx Flashcards

1
Q

What should you aways do if someone comes in from chest pain

A

IV access

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2
Q

What life threatening conditions must you exclude

A 
Acute ACS
Aortic dissection
Tension pneumothorax
PE
Oesophageal rupture
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3
Q

Beware

A

Female / elderly / DM NOT presenting with typical signs

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4
Q

What are key investigations

A 
Hx
ECG - reference to previous
Troponin 6 hours post worst pain 
CXR
Bloods 
D-dimer only if Well's = low probability
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5
Q

What is important in Hx

A 
SOCRATES 
- Character of pain 
- Sudden or with exertion
Any SOB 
Any diaphoresis / nausea
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6
Q

Why CXR

A

Rule of Ddx of ACS

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7
Q

What bloods

A 
FBC
U+E
LFT
Cholesterol 
TFT
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8
Q

If <12 hours + abnormal ECG

A

Emergency

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9
Q

If 12-72 hours

A

Same day assessment

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10
Q

If >72 hour

A

Full assessment
ECG
Cardiac enzyme
Then decide about referral

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11
Q

Other Ddx

A 
Pericarditis 
Pneumonia 
Pleural effusion
Empyema 
GORD
Oesophageal spasm 
MSK 
Shingles 
Intra-abdominal
- Cholecystitis
- Peptic ulcer
- Pancreatitis 
Anxiety = tingling lips / finger 
Sickle cell crisis
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12
Q

What is MSK pain

A

Worse on pain / movement / pressing

May have Hx trauma or cough

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13
Q

What can it be

A

Muscular
RIb fracture
Bony mets
Costrochondriits- viral

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14
Q

What can cause palpitations

A

Arrhythmia
Stress
Increased awareness

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15
Q

What are red flags + admit to AMIA

A

Syncope
Broad complex tachy
2 or 3 heart block
Sustained SVT after vagal

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16
Q

What are 1st line tests (beware may be normal if episodic)

A

Examine CVS inc pulse and BP
12 lead ECG in ALL
Bloods

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17
Q

What bloods

A

FBC
U+E - K?
TFT - hyper?

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18
Q

If there is normal ECG, no PMH and minimal Sx what do you do

A

Safety ned

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19
Q

If concerning features / abnormal ECG

A

Cardiology referral

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20
Q

What do you do for episodic

A

Holter - 24 ECG

Keep a diary of symptoms at time of monitoring

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21
Q

What do you want to know in Hx of dyspnoea

A 
Known resp / cardiac disease 
Anaphylaxis
Onset 
At rest or on exertion 
- How much exertion
- Baseline 
Any orthopnoea - pillow
Any PND
Other Sx
PMH / RF
RF VTE
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22
Q

What other Sx

A 
Chest pain 
Palpitations 
Oedema
Infective - cough / sputum / fever / coryza
RF for VTE
23
Q

What does dyspnoea at rest suggest

A 
Hypoxia or increased work of breathing (if no hypoxia)
FB
Tumour
Bronchitis
Anaphylaxis
Asthma
24
Q

What do you assess for with examination

A 
Wheeze
Stridor 
Chest
- clear
- crep
Signs of overload
Other 
- Pneumothorax
- Pleural effusion
25
Q

Wheeze

A

Anaphylaxis
Asthma
COPD
HF

26
Q

When do you worry and what does it suggest

A

Stridor

  • FB
  • Tumour
  • Acute epiglottis
  • Anaphylaxis
27
Q

When would chest be clear with breathlessness

A 
PE
Hyperventilation
Metabolic acidosis
Anaemia 
Drugs
Shock 
PJP 
DKA 
CNS disease
28
Q

What investigations

A 
Baseline obs - O2, HR, RR, temp 
PEFR
ABG if sats <92% or concern about acidosis 
ECG 
CXR
Baseline bloods 
- FBC, U+E, glucose
- Consider drug
29
Q

Syncope

A

See geriatrics

30
Q

What is syncope

A

Transient LOC due to global cerebral hypoperfusion

Rapid onset, short duration and spontaneous recovery

31
Q

What are mechanism of syncope

A 
Reflex
Orthostatic
Cerebrovascular
Cardiac 
Seizure
32
Q

What is most common

A

Reflex neuromediated

33
Q

What can cause

A 
Vasovagal
Situational
- Cough
- Micturition 
Carotid sinus sensitivity
34
Q

What is vasovagal

A

HR doesn’t increase in response to stimuli so MAP decreases = syncope
Triggered by emotion / pain / stress
Pre-drome - sweat / nausea /
If not recurrent = no further investigation

35
Q

What causes orthostatic

A

Primary autonomic failure

  • Parkinson’s / MSA
  • Lewy body

Secondary

  • DM
  • Amyloid
  • Addison

Drugs

  • Diuretic
  • Vasodilator
  • Alcohol

Volume depletion

  • Haemorrhage
  • Diarrhoea
  • Sepsis
  • Dehydration
36
Q

What can precipitate

A

Prolonged rest
After meals
Venous pooling during exercise or pregnancy

37
Q

What is the classic description

A

Sustained reduction in BP >20 / 10 <3 minutes of standing

May have pre syncope Sx

38
Q

What are pre-syncope

A

Palpitation
Light headed
Blurred vision
Weak

39
Q

Cerebrovascular

A

Stroke
TIA
Subclavian steal

40
Q

What is typical of cardiac syncope

A

Normal after
No memory of event
No prior Sx
Can be recurrent

41
Q

What are cardiac causes

A 
Bradycardia 
- AV conduction
- Sinus node
Tachy - SVT or ventricular
Long QT
Brugada
Drug
Device malfunction
Structural 
- Valve
- MI
- HCM
- Myxoma 
PE - affects R side but will eventually decrease CO
Pericarditis / dissection / tamponade
42
Q

What are red flags

A 
Exertional
Supine
Recent MI
Heart disease
Palpitations
Abnormal ECG
FH sudden death
43
Q

How do you investigate

A 
H+E inc CVS and neuro
Postural BP
ECG 
Bloods 
Urine dip / CXR - rule out infection 
Drug review 
CT head
44
Q

What bloods

A 
FBC, U+E, LFT
CRP
BG
Ca / Mg
Short SYnacthen for Addison's
45
Q

When CT head

A

If anti-coagulation or >65 to rule out subdural

46
Q

What are further test

A

Carotid sinus massage
Tilt table test
- To see if related to change in position or HR
24 hour holter

47
Q

When is carotid sinus +V

A

If pause >3s on ECG after massage

or fall in SBP >50

48
Q

How do you treat vasovagal with no recurrence

A

Avoid trigger
Reassure
Education

49
Q

How do you treat orthostatic

A

TED
Review meds
Ensure no dehydration
Treat DM / neuropathy / Addison’s

50
Q

How do you treat cardiac

A

Pacemaker

AVR

51
Q

DVLA if unexplained syncope

A

NO driving

If no cause found then lift in 6 months

52
Q

If due to seizure

A

6 months if 1st seizure

1 year seizure free

53
Q

If vasovagal attributed to a cause

A

No restriction

54
Q

MI DVLA

A

After 4 weeks

CVS (30 decks)

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